Bottom Line:
Radiographic findings revealed an ill-defined multilocular lesion with a large cystic lesion and thick sclerotic trabeculae on the left anterior maxilla.The radiographic findings in the present case were different from those described in previous case reports.These findings are of special importance due to the unfamiliar radiographic and histologic features of this lesion.

Affiliation: Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju, Korea.

ABSTRACTThe desmoplastic variant of ameloblastoma is a rare form of ameloblastoma characterized by unique radiographic and histologic features. A 46-year-old female was referred to our hospital, complaining of swelling in the left upper lip area. Radiographic findings revealed an ill-defined multilocular lesion with a large cystic lesion and thick sclerotic trabeculae on the left anterior maxilla. After the patient underwent partial osteotomy, histologic analysis revealed a desmoplastic ameloblastoma with no evidence of a hybrid lesion or cyst formation. The radiographic findings in the present case were different from those described in previous case reports. These findings are of special importance due to the unfamiliar radiographic and histologic features of this lesion.

Figure 1: A panoramic radiograph shows an ill-defined multilocular radiolucency with a large cystic lesion extending from the left upper central incisor to the premolar region and displacement of the left upper lateral incisor and canine.

Mentions:
A 46-year-old female visited Chonbuk National University Dental Hospital with the complaint of swelling in the left upper lip area. She had begun to notice the painless swelling two months previously. Her past medical history was non-remarkable. A clinical examination found a bony and hard gingival swelling that extended from the left maxillary incisors to the premolar regions, as well as displacement of the left maxillary lateral incisor and canine. Neither tenderness nor pus discharge was observed upon palpation. A panoramic radiograph (Fig. 1) and a periapical radiograph (Fig. 2) showed an ill-defined multilocular radiolucency with a large cystic lesion extending from the left upper central incisor to the premolar area. Thick sclerotic trabeculae were observed in the lesion, as well as displacement of the left upper lateral incisor and canine. However, no loss of lamina dura or root resorption was observed. Facial computed tomographic (CT) images (Fig. 3) revealed an ill-defined multilocular lesion with a cystic lesion and thick trabeculae on the left anterior maxilla. Thinning, expansion, and perforation of the buccal and palatal cortical plates were noted. The lesion expanded into the left maxillary sinus with destruction of the anteromedial wall and mucosal thickening. With the tentative diagnosis of an odontogenic myxoma or ameloblastoma, the patient underwent partial osteotomy. After an operation, a biopsy was performed, and the histologic analysis (Fig. 4) revealed a non-encapsulated mass with small, scattered tumor nests of epithelium in the fibrous stroma. Small areas of tumor nests showed some columnar cells with reversed nuclear polarity. The stroma showed extensive desmoplasia and new bone formation with osteoblastic rimming. The specimen was consistent with desmoplastic ameloblastoma. The patient has been disease-free for three years since the operation and is under routine follow-up care. The present case differed from the lesions described in previous case reports in that it presented with a multilocular radiolucency that had thick sclerotic trabeculae, and showed no root resorption of the involved teeth.

Figure 1: A panoramic radiograph shows an ill-defined multilocular radiolucency with a large cystic lesion extending from the left upper central incisor to the premolar region and displacement of the left upper lateral incisor and canine.

Mentions:
A 46-year-old female visited Chonbuk National University Dental Hospital with the complaint of swelling in the left upper lip area. She had begun to notice the painless swelling two months previously. Her past medical history was non-remarkable. A clinical examination found a bony and hard gingival swelling that extended from the left maxillary incisors to the premolar regions, as well as displacement of the left maxillary lateral incisor and canine. Neither tenderness nor pus discharge was observed upon palpation. A panoramic radiograph (Fig. 1) and a periapical radiograph (Fig. 2) showed an ill-defined multilocular radiolucency with a large cystic lesion extending from the left upper central incisor to the premolar area. Thick sclerotic trabeculae were observed in the lesion, as well as displacement of the left upper lateral incisor and canine. However, no loss of lamina dura or root resorption was observed. Facial computed tomographic (CT) images (Fig. 3) revealed an ill-defined multilocular lesion with a cystic lesion and thick trabeculae on the left anterior maxilla. Thinning, expansion, and perforation of the buccal and palatal cortical plates were noted. The lesion expanded into the left maxillary sinus with destruction of the anteromedial wall and mucosal thickening. With the tentative diagnosis of an odontogenic myxoma or ameloblastoma, the patient underwent partial osteotomy. After an operation, a biopsy was performed, and the histologic analysis (Fig. 4) revealed a non-encapsulated mass with small, scattered tumor nests of epithelium in the fibrous stroma. Small areas of tumor nests showed some columnar cells with reversed nuclear polarity. The stroma showed extensive desmoplasia and new bone formation with osteoblastic rimming. The specimen was consistent with desmoplastic ameloblastoma. The patient has been disease-free for three years since the operation and is under routine follow-up care. The present case differed from the lesions described in previous case reports in that it presented with a multilocular radiolucency that had thick sclerotic trabeculae, and showed no root resorption of the involved teeth.

Bottom Line:
Radiographic findings revealed an ill-defined multilocular lesion with a large cystic lesion and thick sclerotic trabeculae on the left anterior maxilla.The radiographic findings in the present case were different from those described in previous case reports.These findings are of special importance due to the unfamiliar radiographic and histologic features of this lesion.

Affiliation:
Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju, Korea.

ABSTRACTThe desmoplastic variant of ameloblastoma is a rare form of ameloblastoma characterized by unique radiographic and histologic features. A 46-year-old female was referred to our hospital, complaining of swelling in the left upper lip area. Radiographic findings revealed an ill-defined multilocular lesion with a large cystic lesion and thick sclerotic trabeculae on the left anterior maxilla. After the patient underwent partial osteotomy, histologic analysis revealed a desmoplastic ameloblastoma with no evidence of a hybrid lesion or cyst formation. The radiographic findings in the present case were different from those described in previous case reports. These findings are of special importance due to the unfamiliar radiographic and histologic features of this lesion.